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18C-072 (2) 771 BRIDGE RD BP-2019-1087 GIS#: COMMONWEALTH OF MASSACHUSETTS Mao,Block: 18C-072 CITY OF NORTHAMPTON Lot: .001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Cateaory INSULATION BUILDING PERMIT Permit# BP-2019-1087 Proiect9 JS-2019-001770 Est.Cost $2608.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group, BEYOND GREEN CONSTRUCTION 074539 Lot Size(sp.ft.): 19209.96 Owner: ZAURAS BENTREWICZ KATHERINE Zoning: URB(100)/ Applicant. BEYOND GREEN CONSTRUCTION AT: 771 BRIDGE RD Applicant Address: Phone., Insurance: 13 TERRACE VIEW (413) 529-0544 O WC EASTHAMPTONMA01027 ISSUED ON4/2/2019 0:00:00 TO PERFORM THE FOLLOWING WORK:WALLS, VINYL, 3" DENSE PACK CELLULOSE POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: M Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Sienature• FeeType: Date Paid: Amount: Building 4/2/20190:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner The Commonwealth of Massachusetts 4 lk LQ Board of Building Regulations and Standards FOR Massachusetts State Building Code,780 CMR MUNICIPALITY Building Permit Application To Construct,Repair,Renova Or ft 1 sG E I ,dr M-2 11 One-or Trva-Family Dwellin This Section For Official Use Only Boil gPenmt7Number. #2( -1Q 7 Date Applied: ZVc ',w /255 14 Z-19 Building 011i aW(Print Name) Signature NORTNAMPT0N.MA01 SECTION 1:SITE INFORMATION 1.1 Pro pe Address: 1.2 Assessors Map&Parcel Numbers 7� 1 zr�dclg �d N0ff '(2 tib) I.la Is this an accep street?yeses`h� Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Ares(sq fl) Frovrage(8) 1.5 Building Setbacks(ft) Front Yard Side Yard. Rear Yard Required I Pre ided Requved Provided Requhed Provided 1.6 Water Supply:(M.G.L a 40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Publico Private o Zone: _ Druide Flood Zone? Check if yeso Municipal o On site disposal system c SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: awe,rine 70 C, &nCi,,,CZ ND� IhCm tI�N�W 6i0co C; Name(Print) City,State,ZIP aL' grid�ec Rd Ui3 I No.and Sneet Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction o Existing Building N Owner-Occupied o Repaim s) o I Alteration(s) o Addition o Demolition o Accessory Bldg.o Number of Units_ Other p."Specify: Q i Brief Description ofProposed Worl2: ` — �Jl — Q i ,llul(I� . SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: . Oficial Use Only Labor and Materials 1.Building $ 1. Budding Permit Fee:S Ia'S Indicate how fee is determined: 2.Electrical $ o Standard City/Town Application Fee o Tend Project Costa(Item 6)x multiplier x 3.Plumbing S 2. Other Fees: $ 4.Mechanical (HVAC) $ List: S.Mechanical (Fire Su ression $ Total All Pecs:$ (F 5 2 Check No.j U Check Amount: _Cash Amount: 6.Total Project Cost: $ Cz .3� gyeid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES SECTIONS: CONSTRUCTION SERVICES 1 5.1 Construction Supervisor License(CSL) l.J— �"'(,`cJ7 Q )� a S I i8 SEAN RIEFPOADS J I License Number Expiration Date Name of CSL Holder - Lia CSL Type(sce below) 131' WCB VIEW I Type Description No.add Strect U Unrestricted uildin t m 35,000 cu.R. I R Restricted 1&.2 Feauly Dwelling )AS MA01027 M Meso nry (Chyllbwo, tale,ZIP � RC Roo Coverin WS Window and Siding et, n SF Solid Fuel Burning Appliances 413-529-0544 SEAN(a)BEYONDUREEN.131Z I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 'C? ) -7L/L/ 5erm RJeM id s-HeyondCt Construction HIC Registration Number Expiration Date HIC Company Name or HIC Regiamnt Name 13 Terrace View seanAbevunlinno biC_ No.and Street Email address EasU t MA 01027 413-529-0544 Ci /Town,Stare,ZIP Teletbone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.152.S 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes..........X No...........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1,as Owner of the subject property,hereby authorize to act on my behalf,in all matters relative to work authorized b this building permit application See acil �l 3�251)a Print Owner's Name(Electronic Signature) Daze SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATl N By entering my name below,I hereby attest under the pains and penalties of perjury that all ofth'r information contained in this application is true and accurate 1 best of my knowledge and understanding: Sean Jeffirds 3 Print Owner's or Authorized Agent's Nam 'ignuture) D NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvemem Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Otter important information on the HIC Program can be found at www.mass ov/oca Information on the Construction Supervisor License can be found m www mass eov/dos 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basemenNattics,decks or porch) Gross living area(sq.ft) Habitable room court Number of firepiaces Number of bedrooms Number of bathrooms Number of haltYbaths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. '-Total Project Square Footage"may be substituted for"Total Project Cost' The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 01114-1017 www.massgov/dia 9Workers'Compensation Insurance Affidavit:Builders/Contractora/Electricians/Plumbera TO BE FILED WITH THE PERMITTING AUTHORITY. Aoolicant Information Please Print Legibly Name (BusinessnOrganlaatioNlndividual): i3L'UOIICi �`1ffP(� C(jVlr�'1'YU��'10/� Address: ) �,) jtt(O U )ii(),0 City/State/Zip: ECIW \ tOn,"A Phone#: LIT 599-0,5W/ Areyon au employer±Check the appropriate box: (0)Oa.'} Type of project(required): 1.®IamaemplaYm with�emPloyea lNllaMlor p^-time).' 7. ❑New construction 2.❑Iunawle Mprie mMmashipaodW wempioy worki.g swoons 8. E]Remodeling any"Parry.[No workers comp.announce reyu tri 3.F-1 I em a homenornr doing all work myself[No wwken'corp imvnnce squired.) 9. ❑Demolition a.❑lei.a homcow.und will he hrngc ...w mdu.tan wmkon any popi l win 10❑Building addition eouure and,on mnvmmn tithe,have workers'mmpmsation iwararce or are rule 11.0 Electrical repairs or additions poprimon wim m employee. 12.E]Plumbing repairs or additions 5.❑lon,a general en.mnw am t love hi^e the wl. nuuxaxx hand an the reached strict I3.❑Roof repairs These rb .nuacwn have employee and have w.tke,s''comp,inw.: p� 6.E]We con onumt®d momma hava aeciad Chair right of examptuat per MGL c. 14.E71 Other JV?r) Eri ZG 4lo 153,91(4),and we have rw e,nployas.INo workers comp.imurmce squitd.l 'Any concur that checksbox#1 rout also fill out the cation helm stowing their workers wnrycnsaion policy mfomulion. 'Homwwnm who sahmit Clio affidavit indi®deg they eR donna an wwkmW Nmhhe outride conuwws muu submit a mew effidavir o,dkathtg such. tConnner. thatch«kthic box munumchdmdditianel ahcet dwwhtgthc name ordo wbsmbacwn ed statewhedm or trot thwemtiliw have mnPloYaa. Ifthe wbcwtawmrs M1areamploYaa,May mot provide their wwrken'rumppally mmrber. lam m employer thmispr"iding workers'mnremxion insurancefor my employees Below is thepoltcy dual site information. ^I Insurance Company Name: N O Y C�G.U.f U �n,x U,, Y OJ1 C-0 Policy#or Self-ins.Lic.#: ,rj S oxo i 0005I Expiration Date: Job Site Address: 7 I I:J d e. (�U City/state/Zip:�(1 Attach a copy of the workers'compo It policy declaration page(showing the policy number end exp e). v �C� Failure to secure coverage as required under MGL c. 152,425A is a criminal violation punishable by a fine up to$1,500.00 and/or one,year imprisonment,as well as civil penalties in the furniture STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpenalti ury that the information provided above is nue and correct Signatum Date- PhmeM Oficial use only. Do not write in this area,to be completed by city or man q/JiciaL City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other s Contact Person: Phone ah s - 1 I I �n Commonwealth of Massachusetts - `_� Division of Professional Licensure j Board of Building Regulations and Standards CordipjaMdi% p visor I CS-074539 Upires: 11/28/2020 SEAN R JEPf-0RDS 13 TERRACE WW EASTHAMPTO A 0027, �J Commissioner CZ a-, ! I L/ 9TUI/7.49?.L"/ea& a oAl" COJ2t��G' Office of Consumer Affairs and Business Regulation One Ashburton Place- Suite 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Type: Corporality BEYOND GREEN CONSTRUCTION INC. Registration: 187748 13 TERRACE VIEW Expfla8dn: 05/09/2026 EASTHAMPTON,MA 01027 Updereertd,vseM flMm Gees. ifAl 8 ipA✓h�fi! / ���, i e'.iNN/PM/IMI/���n,��(�irye'�nil✓/�e\ oMceei4bnwROV MnLOOWtRRpulR HDNE a1PWOEMBnsonal RACTOR tsetse 0,tophatior haOVMUNwamdY TYPE:Carlwr✓Es before fconsu consumer m.dabl,and Businund ess is Registration 06"am OMcaofourlonRa Allain ant fiValn9a6 Reguletlon 191746 OSrD9r2020 One AshburNn Placa-Sake 1301 BEYOND GRE'Ef I CONSTRUCnON INC. Boston,NA 02106 1SEAN 3TEJEPFORnE EASTHAACENEW U Not valid without signature FASTHAMPTON.MA 010P U60ersecr�ary .iL e i1lF l . HO+uc Sn:D*OVCTe1f'ln.Liyetl: n.: sonp_iara�L LL°.rwttAWlIDazli:. 3e•�ga:c:J.�l- :::?c.r.:'_+te..e.�.:-:.::v;^�cvs:o.-P�^':n:mii.ei:.: ^r GMae Use On :. Qair S 'ita, We atturauaa, renovation- repair. m: ei zarioLL cor :nr0✓C� ,f,IeinOVRl Or dam03 OP Or the CorlS�iietll,PRI O{ail 8dd{b0[ a aa, pJ -existmg o%Ter o=tied luau wntawtng at wst one but,ao nacre than four dwelling unit,or to structnros winch are adiaccn to s c `5" :ce:i'Dutt6.n*t il.dore:]�re• gtPra (.o +xa:.::Jt,�Sli_".x5(Q'.R CXceptions:aioig ni'uh eine.iaru xc•^.*s- :'. oe e3 CF�Or}:: J'JEcraEtlZ2}IO'1 _ `S.. �USL: -: ;4'orb. '� �,� v lC r� ./ )Qf7Li nc \ewe �`./�CI.�.�1in,Q. —7Q' VY __— +?a cfPerm:�� Applicadon: 02 �Off/ 9 __ is a ne OI: rvkg resw=_(s): .� o!k exc-lude,:by taw lob Linder S 500.09 that: MI MERS PULLING THEIR OWN'PBiUA OR D':.A s V71.1 H '..'�EGISTERED CONTRACT^RS I FORAPPLICABLE t� iWLPiF.t'r 12XT, ' ORt DO NOT HAVE ACCESS :O TH; �) i AR&ISRAT-_ION PROC-IU"kl .,:P GUAR.LN–Y . _T+D UNDER MCL ... i42A. 1, Dena�m of perjury: t L-ceT.�y apply fvr a permit as file agani of the owner. W� Da.e �o:it2ct v0": �_RP- C--'NS,�UC_T_ION R�.t. 731278 4 knee ne'um l her,n,sns'y;ora--�mnce[ t':.e rrvner offfie properzv. 1 :_�_— BEY JN"REEN C © t�1 S T R. U d T v A. DEBRIS DISPOSAL AFFIDAVIT IR ACCORDANCE unlr-rq ... dNLtFfTME.fiLTH MASSA.CIM —77S 7ES^Tv :_SP; S :; F.R,Ci; S,-C>.4t MASSACHUSETTS GENERAL LAW.' CHAPTER 40, SFTO}, 54: A CONDI—uON '—'F BUILDING PERM,—, —... FOR DEMOLMON 'WORK 75-1 `...A.t T-7- D 'KRTc RESUC-FING FRAQM TH_: b`i%7.ri S".att $E r'.EF']04'En SfrE AND DISPOSED n= _% A P OPEf2-..Y _IC.EiYSED S ..�Y; WASTE DISPOSAL FACII.T AS EFi N}D E`:` i•.G'_ C_. CS{_Tv_ ALTERNATIVE RECYCLING, NORTHAMPTON, MA --':S 4.JG'l7CPJ SUE Ai•:)2-5=- �f���rn��� � iti to o BE DISPOSED AND TRANSPORTED 8`�'- €�CPiONO GREEN CONSTRUCT./Z/�id,+%fW fir iT6RR'T'I4rE RECYCLNLq;�r' SIGNATURE DA7F _.--_..__ _1 11`1__.._..- City o s @�t �tor if ��; Yiessacbusetts �4 'Pf-" fn,N GEPBASMEd'1' OF=11DI3T iG 2XSPT+C=0AVS -7� 212 Main S : o i ic.'i Buv ng `0.�, �� ^lT• y, .," liorHiamPtvn, Md 04066 Propetmr Address: —11 4 t'� Ode. RCA �11ti�ti1Q1�- i1 W cont?actor Name: Arff-n C(�`l$'t'rVC'i'iO11 J_ Address: ('tirl�(AfQ V 1 j° City, State: LCA S� h turn 0171 M v i 021 Phone: q 1 ,2 — rJaQ" a 5 J"Y' Property Owner Name:�(Cl�V1ZYi( 2 ]SAV ' GS- �fYIP v`.(^7 Address: City, state: I, 'Se an c 7{� � r 'r('JaS (contractor) attest and affirm that the building 1 intend to insulate does not have any open air(knob and tube)wiring in the spaces to be insulated and that 1 have provided the property owner with a copy of this affidavit. Contractor signature �f tit Date 3�2C �l9 1i�(� Permit Authorization rmss �saw Form smrem m.v.M eeervr�cr Site ID: 3696196 Customer: KATHERINE ZAVRAS-BENTREWICZ owner of the property located at: (0amefa Name,pdmed) 771 Bridge Rd Northampton, MA 01060 (P p "firea[address) (city) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. Owner's Signature: Date: s e�useeeeaeeeeeeseeseeeeeeeseueseee••eeeeesseceseeuueuese+mm ammo FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date Name: CLEAResult Phone: 800-480-7472 Email: Page 1 of 1 For W.C.Use Only Rev.202015 AW�'\ BEYOND GREEN C O N S T R U C T I O N Dear Building Department, Please send permit back to Beyond Green Construction by mail or via email when it is issued. If you have any questions regarding this building permit please call my cell @ 413-539-1728. See details below. Address: Beyond Green Construction 13 Terrace View Easthampton,MA, 01027 Email Address: nicole@beyondgreen.biz Thankyou! Nicolejef ords Bey.ed Green Construction I Project Coordinator Cell:413.539.1728 1 Office:413.529.0544 13 Terrace View,EasNampton I www.beyondgreembiz Beyond Green Construction "Leaders in Energy Efficiency" Phone: 413529.0544 13 Terrace View Established 1998 www.BeyondGreen.biz Easthampton, MA 01027 CSL#74539